Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest

Abstract

Aims Previous studies on sex differences in out-of-hospital cardiac arrest (OHCA) had limited scope and yielded conflicting results. We aimed to provide a comprehensive overall view on sex differences in care utilization, and outcome of OHCA. Methods and results We performed a population-based cohort-study, analysing all emergency medical service (EMS) treated resuscitation attempts in one province of the Netherlands (2006–2012). We calculated odds ratios (ORs) for the association of sex and chance of a resuscitation attempt by EMS, shockable initial rhythm (SIR), and in-hospital treatment using logistic regression analysis. Additionally, we provided an overview of sex differences in overall survival and survival at successive stages of care, in the entire study population and in patients with SIR. We identified 5717 EMS-treated OHCAs (28.0% female). Women with OHCA were less likely than men to receive a resuscitation attempt by a bystander (67.9% vs. 72.7%; P < 0.001), even when OHCA was witnessed (69.2% vs. 73.9%; P < 0.001). Women who were resuscitated had lower odds than men for overall survival to hospital discharge [OR 0.57; 95% confidence interval (CI) 0.48–0.67; 12.5% vs. 20.1%; P < 0.001], survival from OHCA to hospital admission (OR 0.88; 95% CI 0.78–0.99; 33.6% vs. 36.6%; P = 0.033), and survival from hospital admission to discharge (OR 0.49, 95% CI 0.40–0.60; 33.1% vs. 51.7%). This was explained by a lower rate of SIR in women (33.7% vs. 52.7%; P < 0.001). After adjustment for resuscitation parameters, female sex remained independently associated with lower SIR rate. Conclusion In case of OHCA, women are less often resuscitated by bystanders than men. When resuscitation is attempted, women have lower survival rates at each successive stage of care. These sex gaps are likely explained by lower rate of SIR in women, which can only partly be explained by resuscitation characteristics.

Survival in Out-of-Hospital Cardiac Arrest After Standard Cardiopulmonary Resuscitation or Chest Compressions Only Before Arrival of Emergency Medical Services

“…There is substantial variability in survival across EMS systems and several factors that influence the probability of survival after OHCA have been studied. These factors can be patient related such as sex, 42 age, 43 and cause of arrest, 25 or event related. Examples of event related factors are witnessed event, CPR prior to EMS arrival, first recorded rhythm, location of the arrest, and time to defibrillation.…”

Prognostic factors related with outcomes in traumatic out-of-hospital cardiac arrest patients without prehospital return of spontaneous circulation: a nationwide observational study

“…However, this difference could be partially explained by the result of a recent study of OHCA in which female patients had lower chances than male patients to be resuscitated by a bystander and lower rate of an initial shockable rhythm. 17 In our study, metropolitan city was an unfavorable factor for survival to discharge. Cardiac arrests that occurred in rural locations were less likely witnessed by bystanders and approached by EMSs, causing delayed hospital transportation and resuscitation.…”

Frauen und Arrhythmien

“…Dies liegt vor allem daran, dass bei Frauen beim Eintreffen der Rettungskräfte ein sog. "nicht schockbarer Rhythmus" vorliegt, der eine schlechtere Prognose hat als ("schockbares") Kammerflimmern [8].…”